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To X-Ray or Not to X-Ray: Ankle Sprains Decoded

Ankle sprains are one of the most common injuries, affecting people of all ages and activity levels. They can result from a misstep, a sports-related incident, or even a simple stumble. The question that often arises after such an injury is whether or not to get an X-ray. While X-rays are valuable tools for diagnosing fractures and severe injuries, they might not always be necessary for every ankle sprain. In this blog, we'll explore when you should and shouldn't get an X-ray after an ankle sprain, helping you make an informed decision about seeking medical attention.

Ottawa Ankle Rules

Developed in the early 1990s, the Ottawa Ankle Rules are a set of evidence-based guidelines designed to help healthcare providers make informed decisions about whether or not an X-ray is required after an ankle injury. By following these guidelines, physiotherapist, physicians, nurses, and maybe even you, can determine whether you are at high risk for a fracture and need an X-ray.

These guidelines are great for streamlining the X-ray referral process, because it allows those that at high risk to get medical attention with confidence while avoiding unnecessary radiation exposure and healthcare costs for those at lower risk. Here are the main points of The Ottawa Ankle Rules, if the criteria is met, it suggests the need for an ankle X-ray.

  • Pain Points: Do you have pain with finger pressure along either malleoli (i.e the bony protuberances on either side of the ankle)? Do you have pain along the 5th Metatarsal? Do you have point tenderness along the navicular bone?

If you have point tenderness along any of these structures after an ankle sprain - an x-ray is advised.

  • Weight-bearing: Were you able to weight bearing (i.e walk) immediately after the injury? Can you take four steps putting weight through your ankle and foot?

If the answer is no to either of those questions, an x-ray is advised.

When You Should Get an X-Ray

Based on The Ottawa Ankle Rules, if your symptoms advise an X-ray, speak with your medical provider or attend your local Emergency Department. The treatment for an ankle fracture is very different from an ankle sprain and needs to be addressed immediately for best outcomes.

Other things to look for that would suggest an X-ray after an ankle sprain:

  • Severe Pain, Swelling, and Bruising: If you experience intense pain with weight-bearing, immediate swelling and severe bruising, these signs and symptoms may indicate a more severe injury such as a fracture. In such cases, it's advisable to seek medical attention, which may include an X-ray to determine the extent of the damage.

  • Deformity: Any visible deformity, like an obvious bone displacement, is a clear sign that an X-ray is needed. Deformities can be indicative of a fracture that requires proper evaluation and treatment

  • Unable to Move or Bend the Ankle: If you find it extremely difficult to move the ankle or experience significant restriction in its range of motion, this could signal a fracture. An X-ray may be needed to assess the extent of the injury. It is worth while noting that most ligament sprain also present with limited range of motion. Limited range along with your history and other symptoms should be taken into account prior to ordering an X-ray.

  • Previous Ankle Injuries: If you’ve had a history of previous ankle injuries, this may put you more at risk for an ankle fracture. Mention your previous injuries to your healthcare provider during an examination. This information along with a physical assessment can help them make the best decision.

When You May Not Need an X-Ray

  • Mild Pain and Swelling: If you have only mild pain, minimal swelling, and can bear weight on the injured ankle without significant discomfort, you may not need an X-ray. Rest, ice, compression, and elevation (RICE) might be sufficient for treating a simple sprain.

  • Minor Twists and Falls: If the injury was the result of a minor twist or a low-energy fall, and you don't experience any alarming symptoms like severe pain or deformity, then an X-ray may not be immediately necessary. However, monitor your symptoms and seek medical attention if they worsen.

  • Improvement Over Time: If your symptoms gradually improve over the next 24 to 48 hours with self-care measures like RICE, you might not require an X-ray. However, if the pain persists or worsens, it's best to consult a healthcare professional.

  • Medical Assessment: If you're unsure whether an X-ray is necessary, seeking medical advice from a healthcare professional can help. They can evaluate your symptoms and provide guidance on whether an X-ray is needed based on their clinical judgment.

In the realm of ankle sprains, understanding when to pursue an X-ray can be important for your recovery, as ankle sprains are treated differently than fractures. While it's always wise to err on the side of caution, not every ankle sprain demands an X-ray. In ability to weight-bear, tenderness in common fracture sites, as well as severe pain, and deformities, are key indicators that an X-ray is warranted. On the other hand, if your symptoms are mild and gradually improving, an X-ray most likely is not immediately necessary.

Remember, proper medical evaluation and guidance are vital for making an informed decision. If in doubt, consult a healthcare professional who can provide personalized advice based on the specifics of your injury. In any case, don't underestimate the importance of rest, ice, compression, and elevation, along with appropriate care and attention to help your ankle heal effectively.

If you have recently injured your ankle and want an expert opinion or are ready to start rehabilitation - contact Royal City Physiotherapy for guidance. You can call us at 604-553-1203, or book an appointment online by clicking here.


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